This notice details how your medical information may be used and disclosed and how to gain access to that information. Please review carefully.

By law, every pharmacy is required to maintain the privacy of “Protected Health Information” (PHI), in addition to providing the individuals with notice of those legal duties and practices of privacy with respect to PHI. PHI is the information that may identify an individual and relates their past, present and future health (mental or physical) or condition and associated health care services to them. This “Notice of Privacy Practices” (“Notice”) explains how a pharmacy may use and disclose your PHI to carry out Health care operation, treatment or payment and for other pre-determined purposes that are permitted or required by law. This Notice also explains the rights of an individual with respect to the PHI about them.

Individual Health Information Rights

With respect to your PHI, you have the following rights:

-Upon request, to obtain a paper copy of the Notice
-To request guidelines on certain uses and disclosures of your PHI
-To attain and inspect a copy of PHI
-To request an amendment of PHI
-To receive an accounting of disclosures of PHI
-To request communications of PHI

Additional PHI Uses and Disclosures

Additional purposes, beyond those previously discussed or as authorized or allowed by law, may cause the pharmacy to request an individual’s written authorization for PHI disclosure or use. Authorization may be revoked at any time. The Pharmacy, after receiving a written revocation, will discontinue disclosure and use of an individual’s PHI beyond actions already completed in association with the original authorization.

To Report a Problem or For Additional Information

Please contact the Pharmacist in charge of Tahoe Valley Pharmacy with additional questions or for more information about the Pharmacy’s privacy practices. In the case of suspected violation of privacy rights, please file a complaint with the Secretary of Health and Human Services Douglas W. Mundy R.PH. Filing a complaint will in no way result in any retaliation efforts.

This Notice is effective as of April 14, 2003

Examples of Use and Disclosure of PHI

The following are examples and descriptions of the uses and disclosures of PHI

-The use of PHI for treatment
-The use of PHI for payment
-The use of PHI for health care operations

A pharmacy is likely to disclose or use PHI for the following purposes:

-Business associates
-Communications with individual involved in your care or payment for your care
-Health-related communications
-Food and Drug Administration (FDA)
-Worker’s compensation
-Public health
-Law enforcement
-As required by law
-Health oversight activities
-Judicial and administrative proceedings

A pharmacy is allowed to disclose or us PHI for the following purposes:

-Coroners, medical examiners and funeral directors
-Organ or tissue procurement organizations
-Correctional institution
-To advert a serious threat to health or safety
-Military and veterans
-National security and intelligence activities
-Protective services for the President and others
-Victims of abuse, neglect, or domestic violence